Dear Parents,We are not so different in our day to day lives. I have a high school and a middle school student, too. They watch Netflix as much as yours does. Just like you, I monitor what they watch as much as I can. And just like you, I cannot prevent them from being exposed to films that are detrimental to their brain development. But I can try.

I’m writing you, each parent as an individual peer, to encourage you to pay close attention to the mini-series on Netflix called “13 Reasons Why”. It’s based on a fictional book written by Jay Asher. It’s a show about a high school student named Hannah. Hannah completed suicide, and she left behind a set of tapes that explain theevents that led up to her choice—and she openly blames 13 people for the reasons why she took her own life.

I watched every episode. Yes, every minute of every episode and compared it to the book. I even watched the 14th episode in which producer Selena Gomez explains why she made it so graphic. She even included interviews with the psychologist and counselors she consulted with.

Shame on those consultants. They should have known what these films might do to our youth. Ethically, I have a huge problem with what they allowed in the making of this film. Even the young actors talked about how traumatizing it was for them to make the film. And it was all fiction. But they claim they made it based on reality.

Well, maybe it was. At least the two rapes and the act of suicide were pretty real looking. But I want to talk with you about the content. The content of the episodes have a few running themes that left me gravely concerned for the young people living under my roof, and the young people who come to see me for help. I am even moreconcerned for the multitudes of youth who I cannot reach—who I cannot impart any of my knowledge, wisdom, or discernment to.

First, Hannah does a beautiful job of making herself the martyr. In almost every episode she makes an impulsive decision that compromises her integrity and/or her safety. Then, she blames the consequences for those decisions on the people who either didn’t help her or the people who hurt her. This is by no means making excuses for or justifying the peer abuse that clearly happened as a result of these incidents. Her choices ranged from letting friends take pictures of her without her consent to sneaking out of the house to go to a party where teens are doing drugs and drinking alcohol. Hannah, not her peers, made these choices to allow herself to be in situations that could result in her becoming harmed. Hannah also chose not to remove herself from those situations when she became unsafe.

Second, the film does a poor job educating viewers on the alternative choices. Not one episode showed us how Hannah could ask for help. In fact, she refused the little help she was offered—over, and over again. There were several instances early on where people came to Hannah and offered support or help to resolve a problem. ButHannah refused. I understand this really does happen, and I also understand how depression distorts the way you perceive things. I would have loved to see at least one character, such as her parent or teacher, insist she see a professional therapist for a full evaluation. Her resistance to offers of help encouraged people to stop offeringrather than insisting. But it was made for Hollywood, so there can’t be an acceptable solution—it must contain drama and cliffhangers.

Finally, the film does a poor job portraying the seriousness of adolescent depression and the decline of a teen’s mental health. Instead, it focuses on the mysteriousness of what each person did and the hidden agendas of everyone’s secrets. It is intended to leave you feeling Hannah’s decision was justified, and that her peers are to blame for her choice to end her life. “Poor Hannah” is the end, and blame is the means to justify the end.

Nearly all the teens I know have watched part or all of the series. It is affecting them, and messing with the way they think. In the past week, I talked with 8 teens, and all but one shared they have an increase in suicidal ideation as a result of watching the film. This is not to say they are wanting to kill themselves, but it is affecting their filters and distorting their cognitions.

I encourage you to not let your kids watch the film; however, it’s probably too late for that. In that case, have a very real conversation with them. Let them know the following: You are ready to listen. (Then listen to them!!) Listen in a way that you are not trying to solve their problems; be non-judgemental. And listen without showing your reactions. Kids will not confide in parents about scary things because parents generally over-react. Assess for risk of suicide or self-harm.o Ask them directly, “Are you having thoughts of wanting to kill yourself?”o If they say yes, then explore whether they have a plan.o If they have a plan, ask yourself do they have the means to carry out that plan. If the answer to this is yes, the risk is high and you need to take your child to the nearest emergency room for an evaluation. Give information and resources.o If they have insurance, let them know whether their insurance covers getting professional help.o Be prepared to make a phone call and set up an appointment for them with a professional therapist or psychiatrist. Please don’t use your family friends to fulfill this need. It’s unethical for licensed mental health professionals to provide therapy for their friends, family members, or children of their friends. It would be risking our license to provide that help.o Call United Way at 211 or visit their directory on-line at www.211.org for finding a qualified professional near you.o Tell your teen to take their phone out and enter a new contact: National Suicide Hotline at 1-800-273-8255. Tell them to give that number to a friend if they have a friend who might need it. Once you find a therapist for your child/family, have your teen put the therapist’sinformation in their contacts as well. Encourage appropriate professional help.o Make it a priority to attend therapy sessions with your teen, or be willing to take them on a consistent basis.o Pay their co-pays on time, and make sure paperwork is completed for them. Sign all the appropriate releases to ensure the best care possible.o Talk with your pediatrician or family doctor to help provide oversight and guidance about the level of care needed. Encourage appropriate self-help.o Make sleep a priority, and help your teen develop a consistent routine.o Spend time as a family. Eat meals together. Have your teen get involved in family time.o Increase positive social connections. Have friends over rather than letting them go somewhere you are not sure about. Monitor and supervise—bring them snacks, ask how things are going, find out about what’s happening at school.o Eat a nutritious, balanced diet.o Play at least as hard as you work—as a family!o Role play possible solutions when difficult things come up. For example, if your daughter is being sexually harassed at school, role play scenarios where you show her how she can use the skill of distraction. This could be something like saying dramatically, “You want to touch my what???” This would draw attention to the people doing the harassment and they would likely back off and not repeat the behavior.o Empower your teen to be the captain of their own destination. Advocate and defend when needed, but encourage them to take control of intimidating situations themselves. Teach them about not handing over your power, and to prevent being a target through assertiveness training. As a parent, make them use critical thinking and problem solving approaches with you.

These are just a few ideas of how to help your teens deal with depression, anxiety, and suicidal thoughts. And this is just the tip of an iceberg for ideas. Get involved and be the one person who always has his or her back—no matter what. Validate their concerns by listening, and reflect back what you understood. Validating does not mean you agree, it simply means you heard them. A parent who hears is a parent who can be trusted with the biggest feelings and thoughts teens are struggling with.​My final thought is more of an invitation. I’m in the business of saving lives, but I am only one person. We are all in this together. What you do as a parent matters more than any other person who plays a role in your child’s life. Be the nurturing protector, and share how you think 13 Reasons Why is not a healthy choice for them.

Chronic pain is not a traditional type of “problem” that many associate with seeking counseling. Typically, mental health services are associated with depression, anxiety, or substance use. Chronic pain is a mental health issue, and I would encourage individuals with chronic pain to consider the emotional implications and causes in regards to their pain. A licensed professional can help the individual process through traumatic events or stressors in their life that may be increasing, prolonging, or ultimately worsening the individual’s chronic pain.The medical community is one in which chronic pain remains a mystery. Medically speaking, most injuries are fully healed within one to three months, excluding severe spinal injuries or nerve damage which may not fully restore to their previous states. During this time, pain is classified as ‘acute’ due to the proximity to the actual injury that has occurred. Any and all pain is rightfully attributed to the injury that has occurred at that time. Pain is the body’s way of having the individual slow down, use the afflicted area less, and allow it the time it needs to properly heal. Pain lasting longer than three months is considered chronic pain. In his book, The Hidden Psychology of Pain, Dr. James Alexander discusses and explores five myths related to chronic pain and how the brain can trick the body into hiding emotional trauma or stress as physical pain.

Chronic pain is the result of damage.This is an inaccurate assumption. Yes, pain occurs after an injury; however, this is termed acute pain due to the proximity to the actual injury or event. Chronic pain is defined as pain that lasts longer than three months but medically speaking, the injury has or should have healed. Chronic pain is a medical mystery. Typically, a medical professional is looking for a specific cause (injury, abnormality, etc.) from the structural makeup of the individual’s body to arrive at a diagnosis. Chronic pain often times is more intense than the medical profession feels a specific injury should be (given that pain is subjective), giving rise to the idea that medically there is no explanation for why the pain is as intense as the individual reports or why it is persisting past the expected healing time.Chronic pain is evidence of spinal/body weakness and vulnerability.Our bodies naturally change as we age. Abnormalities of the spine or other bodily structures are normaland expected as we age. The medical profession only sees the patients whom are experiencing pain. They run a battery of tests (x-rays, CT scans, MRIs, etc.) to try to find the culprit or pinpoint a specific cause. There is little in terms of guesswork used to arrive at a cause/diagnosis, but typically hard evidence found through the use of these tests. A lot of the abnormalities found could be attributed to the typical aging process. Someone without pain of similar age and health could have the same or similar result in the tests as an individual with pain. However, the medical profession does not see these individuals, as common sense implies that if you are not in need of a doctor (i.e. not in pain) then you would not seek out their services. Why is it that some people develop chronic pain and others seem to not experience any? This lends evidence to emotionally stored traumas or stressors within the body and the mind/body connection.Chronic pain is only likely to get worse with time.This stems from the idea that pain comes from injury or damage. Medically speaking, after three months any injury should be healed. While there are some disorders or injuries, such as nerve damage, that do not have a fix or that cannot be healed, they should not get worse in severity. Take for instance nerve damage. Dr. Alexander argues that injuries such as nerve damage would not lead to increased intensity of pain, but rather would lead to the nerve dying off and no longer functioning at all, possibly alleviating the presence of pain. As therapists, we understand how thoughts can have a great impact on our moods, emotions, and behaviors. Same applies to pain. If the individual gets the notion that the pain will only get worse as there is no cure or clear cause, their brain works with that idea and creates the impression of worse pain. This starts a negative feedback loop, where their thoughts influence the pain, and the increase in pain reinforces their thoughts, which leads to a continuation of this pattern. CBT (cognitive-behavioral therapy) is a good tool to use to combat the thinking errors found in this negative feedback loop.Chronic pain is ultimately crippling.This ties in to the above discussion and reflects on the negative feedback loop that is often the case with many individuals suffering from chronic pain. Many times, individuals with pain will decrease their activities in an effort to avoid further injury or to avoid pain through activity. This is counterproductive to actually helping alleviate pain. Most medical professionals will agree that there is a time immediately after an injury in which the person should be more cautious and take it easy - resting more frequently - to allow the body time to heal. However, if the individual remains immobile, they will find that the pain is worse. Muscles can atrophy (essentially waste away) without consistent use. Once this occurs, more pain is likely, as the body is drawing on other areas in order to function and move. Movement actually plays a big role in pumping oxygen to our muscles. When muscles become oxygen deprived, they can become painful and/or more susceptible to injury. Worry about further injury prevents an individual from moving, which makes the ischema (lack of oxygen in muscles or tissue) worse, and again another negative feedback loop is occurring. Movement is highly encouraged when dealing with chronic pain. Chronic pain precludes independence or the ability to earn.This is another thinking error in regards to the effects of chronic pain. Individuals can begin to worry and stress over the impact their pain will have on their ability to do their job, provide for their family, or to maintain independence physically from others. This thought increases the likelihood that an individual may develop chronic pain. The persistent fear and worry of these negative outcomes can increase the amount of pain one feels. Our brains are amazing organs and sometimes it is easier to deal with the physical pain than the emotional. Thus it can create the perception of an increase in the physical pain so that deeper underlying issues are not in the forefront of the individual’s mind, acting as a defense mechanism.In my next blog, titled Chronic Pain Part 2: The Brain, I will discuss how our brains interpret and add emotional value to injuries which can increase our likelihoods to develop chronic pain in the future, as well as how our brain works to protect us through the use of pain as a deterrent (defense mechanism).ResourceAlexander, James. (2014). The Hidden Psychology of Pain. Bloomington, IN: Balboa Press.